Provider Demographics
NPI:1740280031
Name:GREENE, CHARLOTTE S (PA)
Entity type:Individual
Prefix:MS
First Name:CHARLOTTE
Middle Name:S
Last Name:GREENE
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:15 HOSPITAL DR
Mailing Address - Street 2:THEBAUD BUILDING, FOURTH FLOOR
Mailing Address - City:YORK
Mailing Address - State:ME
Mailing Address - Zip Code:03909-1011
Mailing Address - Country:US
Mailing Address - Phone:973-267-2293
Mailing Address - Fax:973-267-3144
Practice Address - Street 1:15 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909-1011
Practice Address - Country:US
Practice Address - Phone:207-351-2478
Practice Address - Fax:207-351-2216
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2016-03-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MEPA1549363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q01819Medicare UPIN
Q01819Medicare UPIN